The invention relates to clinical information reporting systems.
Each year, over 500,000 Americans die of acute myocardial infarction (AMI, known as "heart attack"), including over 200,000 in hospitals. Were the medical advances of the last two decades consistently used, the mortality rate for hospitalized AMI patients would be much less. Medical care in this country's 6,000 hospitals varies, and current national AMI mortality rates are about twice those reported from major research centers. The problem is that physicians and hospitals do not consistently deliver optimal cardiac care.
Two fundamental problems underlie the failure to translate medical advances into results in this country's hospitals: 1) delays and errors in emergency room (ER) physician decision-making about the immediate care of the AMI patient, and 2) the lack of any credible and practical way to monitor and evaluate hospital AMI care results.
The key advances in AMI care relate to the very first hours of care: new medications and procedures for immediate use, and admission to the coronary care unit (CCU). Even short delays in treatment can cost lives in the first few hours, as can mistakes in CCU admission, but both are currently common. Delays occur as ER physicians try to sort out and treat AMI patients from among the many others they must evaluate. For example, the typical ER delay in giving thrombolytic therapy is about two hours, despite its well-known loss of its life-saving effect if not given promptly. Admission decisions to the CCU are also often suboptimal. of the early 1.5 million patients admitted to CCUs in this country each year, fewer than half have true acute cardiac ischemia (the diagnosis including AMI as well as "unstable angina pectoris", which can quickly progress to an AMI), thus filling CCUs with unnecessary admissions. More costly in lives, each year approximately 20,000 AMI patients are inadvertently sent home from the ER without any care.
Once primarily the concern of physicians and researchers, because of the scale of the problem, the Federal government is now looking for ways to monitor, evaluate and improve the delivery of AMI care. Over the past two years, separate expert panels have been convened by the Health Care Financing Administration (HCFA), the Agency for Health Care Policy and Research (AHCPR), the National Institutes of Health (NIH), and the Institute of Medicine of the National Academy of Science, to find ways to improve the delivery of cardiac services. In each case, these panels and agencies have concluded that two major approaches are needed: 1) in order to improve the quality and speed of physicians' emergency care of AMI patients, methods are needed to assist physicians' emergency decision-making; and 2) in order to detect suboptimal care and to encourage continuous improvement, methods are needed to objectively assess the quality of physicians' and hospitals' AMI care.